JeffHOPE is a student-run organization with five clinics that works to bridge access to healthcare for the homeless population of Philadelphia. As a steering committee member, many of the patients I have encountered will impact my future practice for decades to come. A particular patient comes to mind: he stopped by our street-side clinic and asked to be screened for HIV and Hepatitis C. Something about this man’s demeanor made me concerned, so I used one of the only tools I have as a second year medical student – a listening ear. I asked him how things were going and, after just a few minutes, he shared that he was feeling suicidal and that he had actually thrown himself in front of a bus the night before. Subsequently, the local ER turned him away after telling him that he was there “just to get out of the rain and get a bed.” I then noticed a tremor in his hands. I asked about this and he bluntly responded, “Those are the DTs, man.” (delirium tremens). I worked with the resident to get the patient accepted into a detoxification program immediately.
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When I talk about experiences like this one, the feedback I often get from faculty and mentors goes something like this: “You’d be great in psychiatry,” or “You’re a primary care guy.” While I have tremendous respect for these specialty choices, this type of response upsets me. The sentiment expressed in those comments is upsetting because it implies that students who care about social justice and homelessness are somehow best suited for a career in primary care or will not succeed in a surgical specialty. To me, this is flawed for many reasons. First and foremost, marginalized members of society need access to specialty care just as much – and sometimes even more – than individuals with greater means. Unfortunately, research shows that an individual’s zip code is a strong independent predictor of their health outcomes and poverty is a well-known contributor to this issue.1 Second, if we keep convincing students who are passionate about caring for marginalized populations to go into primary care, we will decrease the number of providers in our specialty fields who are dedicated to promoting health equality. I worry that more and more patients in dire need of specialty services will be turned away and labeled “difficult” or “non-compliant” or “just wanting a bed to get out of the rain.”
I have expressed this concern to faculty and friends, and occasionally I have been met with the following: “It is good to start off idealistic.” I understand that aspiring to maintain this level of idealism might be difficult, but I intend to try. I hope that my future patients will appreciate it, and I know that I will feel content with myself for giving it my best. For me, having the privilege of becoming a physician requires that I start with and try to maintain this idealism.
1. Dwyer-Lindgren, L., Bertozzi-Villa, A., Stubbs, R. W., Morozoff, C., Mackenbach, J. P., Lenthe, F. J., . . . Murray, C. J. (2017). Inequalities in Life Expectancy Among US Counties, 1980 to 2014. JAMA Internal Medicine, 177(7), 1003.